Nurs Dip BSc Nurs PGDIP Palliative care UNC Lilongwe Palliative Care WHO definition of Palliative Care 2002 Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with lifethreatening illness through the p ID: 810810
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Slide1
Paula Ward RGN, Palliative CNS, Nurs Dip, BSc Nurs, PGDIP Palliative careUNC Lilongwe
Palliative Care
Slide2WHO definition of Palliative Care (2002) Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain
and other problems,
physical, psychosocial and spiritual
.
Slide3Palliative care Palliative care is more than just pain reliefIt includes addressing the physical, psychosocial and emotional suffering of patients with
life threatening illness and supporting the
family
providing
care to a loved
one
About one third of those needing palliative care suffer from
cancer
Slide4Total Pain
Slide5Palliative CareWhile still a relatively new speciality to modern healthcare, it is increasingly recognised as an essential part of all healthcare systems Despite this, it is widely acknowledged that there is still inadequate access to hospice and palliative care worldwide
Slide6World Health Assembly resolution WHA67.19The first ever global resolution on palliative care in 2014 Called upon WHO and Member States to improve access to palliative care as a core component
of health systems, with an emphasis on primary health care and community/home-based
care
While recognizing that the limited availability of palliative care services in much of the world leads to great,
avoidable
suffering for millions of patients and their families
Slide7Why palliative careEnhances quality of life and may positively influence the course of illnessIs applicable early in the course of illness, in
conjunction
with other therapies that are intended to prolong life such as chemotherapy or
radiotherapy
Affirms
life and regards dying as a
normal process
Slide8Why palliative careIntegrates the psychological and spiritual aspects of patient careOffers a support system to help patients live as actively as possible until deathProvides relief from pain and other distressing symptoms
Slide9Global Provision of Palliative Care136 of the world’s 234 countries (58%) now have one or more hospice-palliative care services established Malawi falling in the Preliminary integration category
O
nly 8.5% countries (20) have “
Advanced integration
’ of palliative care services
WPCA report Mapping Level Development 2011
Slide10Global Provision of Palliative CareEach year, an estimated 40 million people are in need of palliative care, 78% of them people live in low- and middle-income countries.Worldwide, only about 14% of people who need palliative care currently receive it.
WHO, 2015
Slide11Global Cancer Burden Cancer is a leading cause of death worldwide, accounting for 8.2 million deaths in 2012 More than 60% of world’s total new annual cases occur in Africa, Asia and Central and South America. These regions account for 70% of the world’s cancer deaths
.
World Cancer Report 2014
Slide12The late presentation of cancer patients (it is estimated that 80% of cancer patients have advanced incurable disease at first presentation), inadequate diagnostic facilities, poor availability of chemotherapy and radiotherapy, and absence of the WHO stepladder approach
, all increase the need for improved adequacy of cancer pain
control in
Africa
(
Minja
, 1989)
Slide13When does palliative care Start?
Murray SA, Kendall M, Boyd K, Sheikh A. Illness trajectories and palliative care. BMJ. 2005; 330:1007-1011
Slide14Early referralEvidence has shown that the introduction of palliative care services early in the course of advanced cancer improves a number of salient outcomes, such as quality of life, symptom burden, mood, and use of health care servicesIncreasing evidence supports offering concurrent palliative care and standard oncologic care at the initial diagnosis of advanced NSCLC and should be considered for any patients with metastatic cancer early in the course of disease.
Slide15Palliative care in AfricaZimbabwe's Island Hospice Service (founded in 1979) considered to be the first in a developing countrySouth Africa 1980Nairobi 1990
Pioneered by Hospice Africa Uganda in Kampala (started 1993)
161 services in 17 countries (out of total 56 countries,2006 data)
• African Palliative Care Association (APCA) founded 2003:
‘
To promote and support affordable and culturally acceptable palliative care throughout Africa’
Slide16Palliative Care in Malawi 2002 first palliative care team in paediatric department in QECH2006 First Hospice Ndi Moyo Salima
Current Situation:
5 palliative care centers of excellence
Lighthouse, Lilongwe
Palliative Care Support Trust, QECH (Adult &
Paediatirc
)
Ndi
Moyo
, Salima
Bangwe
Palliative Care Project
St
Gabriels
Family centered hospice (
inpt
& community based)
Slide17Palliative Care - ChallengesWidespread lack of understanding of what palliative care actually is and its corresponding benefitsOften perceived to be synonymous with end of life care, death and hospice, or as a means of relief for physical pain exclusively
Lack of training and awareness of palliative care among health professionals is a major barrier to improving access
Overly restrictive regulations for morphine and other essential controlled palliative medicines deny access to adequate pain relief and palliative
care in developing countries
Slide18Opioid accessImproved access to oral morphine is mandatory for the treatment of moderate to severe cancer pain, suffered by over 80% of cancer patients in terminal phase WHO
Slide19Palliative Care Malawi – Challenges Provision of palliative care is “patchy”Limited drug availability including consistent opioid stocksLimited chemotherapy provisionNo available radiotherapy R
esource
limitations and poor
infrastructure
Late presentation or diagnosis
Inadequate diagnostic skills and assessment
Slide20Palliative Care Malawi- StrengthsIntegrated palliative care in the HIV and AIDS national health policyNational palliative care guidelines(2011) and national policy (2014)availablePalliative care is integrated in the curricula of health professionals
Has developed and are implementing a palliative care national training package
Slide21The worldwide need for palliative cancer care to relieve the suffering of patients and families living with cancer is greater than everThe importance of palliative care is being emphasized by the WHO Global Action Plan for the Prevention and Control of
Noncommunicable
Diseases 2013–2020 and the most recent WHO essential medicines list that includes a specific section on medicines for palliative care.
Slide22In ConclusionPalliative care for cancer patients has been shown to bring many benefits in regard to symptom burden; physical, psychological and spiritual. It is clear that there is an unmet need among patients in Malawi Therefore improved access and availability of palliative care is essential in order to provide holistic care
Integration
of palliative care into existing health care
systems is essential
Slide23Lucy Finch, Founder Ndi Moyo, Salima
Slide24Palliative CAre
Slide25Thank you“You treat a disease you win, you lose. You treat a person I guarantee you will win no matter what the outcome.”
Patch Adams